The title above is not an abstract statement or a philosophical question. Hence, what follows is not a speculative or metaphysical piece. It is an evaluation of the concrete, experimental data on the merits of music therapy in the treatment of brain injury, particularly one due to a stroke. A stroke or a cerebrovascular accident (CVA) is a sudden event, much like a heart attack, due to either an obstruction in the blood flow or hemorrhage in a specific region of the brain. Various rehabilitative modalities are often required to help victims regain function. Although not a mainstay of post-stroke care, there is a robust, albeit small, body of scientific papers supporting the use of music therapy as an adjunct intervention in certain neurological illnesses.
Dr. Michael Thaut of Colorado State University in Fort Collins has conducted pioneering research in this field for close to two decades now. In 2002 he demonstrated that a metronome like beat presented to stroke patients with right arm weakness improved both the speed and accuracy of tasks performed by the affected hand as compared to when the same exercise was attempted in the absence of any auditory cues. Five years later, in a larger study he and his colleagues showed a similar improvement in gait after CVA when training was done with rhythmic sounds versus without any sonic prompting. Thaut also reported that singing a series of words rather than repeating them without music improved retention of material and reduced errors in patients with cognitive compromise due to multiple sclerosis, another disorder of the nervous system.
Drs Teppo Särkämö and David Soto, of the University of Helsinki and Imperial College London respectively, presented equally intriguing results in 2012. Patients with visual disturbances due to stroke had greater improvement in their vision while they listened to their preferred music vs. when they listened to non-preferred music or nothing at all. Specialized medical imaging techniques, called functional magnetic resonance imaging (fMRI), showed an increase in activity in the area of the brain that is involved in language production as well. To determine the long-term benefits of musical exposure, Särkämö and Soto randomly divided sixty patients with large strokes affecting similar areas of the brain into three groups. One listened to music of their choice for a minimum of 1 hour per day for two months, the second group did the same with books on tape and the third group was not offered any listening material. All sixty received standard of care rehabilitation services otherwise. Assessed with the use of standardized testing, at one week, three months and six months the music group had significantly greater improvement in memory, mood and attention, and significantly less confusion compared to the other two groups. All these stroke studies, although fascinating, utilize passive exposure to music and rhythm. What about active music playing? How does that impact recovery from a CVA? Can actually playing music, especially the spontaneous performance of it, lead to greater improvement in brain function than just mere passive enjoyment of it? The Case of Louis Smith
For Blue Note label aficionados, trumpeter Louis Smith is a familiar name. Born Edward Louis Smith in 1931 in Memphis, Tennessee, he recorded four albums between 1957 and 1958 for the label. Two were as a leader; Here Comes Louis Smith
(Blue Note, 1958) and Smithville
(Blue Note, 1958) and two others as a sideman; guitarist Kenny Burrell
's Blue Lights
(Blue Note, 1958) and pianist Horace Silver
's Live at Newport '58
(Blue Note, 2007). He then took a twenty-three year hiatus to devote himself to teaching at various public schools & universities in Georgia, Tennessee, Kansas and Ann Arbor, Michigan. Here he spent the last seventeen years of his educational career at Ann Arbor Junior High School and as a director of the University of Michigan's Jazz Band. He returned to the studio in 1978 and cut a dozen superior records for Steeplechase,the majority of them after 1990. In 2006, Smith suffered a massive stroke to the left side of his brain. As a result his right arm and the right side of his face were completely paralyzed and he had very little strength in his right leg.
The most devastating consequence of the CVA, however, was his loss of linguistic abilities (a condition called global aphasia). He was unable to produce any speech (verbal or written) and had very little language comprehension. After weeks of multi-modal interventions and a modest degree of physical recovery, his aphasia had not much improved. His high level of education, the strong support of his family and friends, particularly that of his wife; and that he lived in an intellectually enriched environment were all favorable odds for recovery. His age (over 75 at the time of the event) and the large size of the damaged area, however, were major disadvantages. The team working with Smith told his wife Lulu that there was nothing more they could do and that Smith and his family should come to terms with his impairments.
Not everyone threw in the proverbial towel. University of Michigan, speech language pathologist, Dr. Gordon Krainen, PhD, CCC-SLP and board certified music therapist Lynn Chenoweth, MT-BC, came up with a uniquely ingenious method to help Smith regain his language; they had him play music. Demoralized by his disabilities, Smith was originally reluctant to pick up the trumpet. Chenoweth coaxed him into playing by asking him to teach her the instrument. Friends made a custom stand for Smith's trumpet until Smith learned to play left handed and gained a bit more use of his right hand.
Chenoweth worked with him on his horn playing, singing and speech production using a technique called Melodic Intonation Therapy (MIT). Designed by Dr.Martin L. Albert, Robert W. Sparks and Nancy A. Helm, and utilized at the behest of Dr. Michael Thaut of Colorado State University (see above), MIT helped Smith retrieve some functional language. Krainen, an accomplished pianist himself, helped Smith rehearse and helped him regain some speech by associating names of instruments with Smith's favorite jazz musicians. Eight years later Smith is continuing to make progress playing his trumpet left-handed and beginning to improvise. He has mostly recovered his language comprehension and verbally expresses himself, though considerable difficulty remains. Most importantly, he is no longer despondent and depressed, especially when able to pick up and blow his horn, albeit hesitantly, with the lyricism that marked his life's work as a musician.
The Youtube video here shows him playing in Chicago, on November 16, 2013 at the annual ASHA convention after our seminar titled "The Restorative Power of Music for a Jazz Musician With Global Aphasia." Dr. Gordon Krainen accompanies him on the piano. Why and how would playing jazz help language recovery?
In order to form a plausible hypothesis it is important to start with what happens in the healthy brain while improvising. Drs Charles Limb, Mónica López González and Allen Braun of the NIH and Johns Hopkins University, study the brain functions of jazz and rap musicians during both improvisation and interpretation of prewritten music. They utilize the fMRI technique mentioned previously. Their research has shown that, during ad-libbing or free-styling, activity increases in areas of the brain responsible for autobiographical narrative and internally motivated, self-generated, and stimulus-independent behaviors. In addition, there is a heightening of brain activity in all sensory areas. More importantly, large regions that are responsible for monitoring planning and on-line adjustment of goal directed behaviors are quiescent. It is, hypothetically, possible that widespread decreased activity allows more of the meager resources of an injured brain to be shifted to the primary language areas, leading to faster and more effective healing. As mentioned, listening to music increased activity in this very region of stroke victims' brains. It is, therefore, a credible assumption that actually improvising music would lead to even more stimulation of that particular section of the brain.
By the same token, experiencing music passively has shown to improve attention, counteract the physical effects of low mood and anxiety, and help with memory. The latter is because memories for certain events associated with particular musical sequences are encoded and stored together. Conceivably, therefore, making music on the spot may further enhance these benefits. Lastly, music is a form of expression so it stands to reason that engaging in its creation may lead to improved communication overall.
It is quite fascinating that the compelling human need to produce music, although it serves no apparent evolutionary purpose, can mend the very organ responsible for its inception.
Koelsch, S. (2009). A Neuroscientific Perspective on Music Therapy. Annals of New York Academy of Sciences. 1169, 374-384
Limb, C. J., & Braun, A. R. (2008). Neural substrates of spontaneous music performance: An fMRI study of jazz improvisation. PLoS ONE, 3(2), 2-9.
López-González, M., & Limb, C.J. (2012). Musical creativity and the brain. Cerebrum, 2. Epub 2012 Feb 22.
Särkämö, T & Soto, D. (2012). Music listening after stroke: beneficial effects and potential neural mechanisms Annals of New York Academy of Science 1252, 266281
Thaut, M.H., Kenyon, G.P., Hurt, C.P., McIntosh, G.C., & Hoemberg, V. (2002) Kinematic optimization of spatiotemporal patterns in paretic arm training with stroke patients. Neuropsychologia 40 (7), 10731081
Thaut, M.H., Leins, A.K., Rice, R.R., et al. (2007) Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial. Neurorehabilitation and Neural Repair. 21(5), 455-9
Thaut, M.H., Peterson, D.A., & McIntosh, G.C. (2005). Temporal Entrainment of Cognitive Functions. Annals of New York Academy of Sciences. 1060, 243-54.